August 27, 2009

Frontal Sinus Fracture

Axial CT image shows a depressed, comminuted fracture of the anterior wall of the frontal sinus. There is small hemosinus. The posterior wall is intact.
3D CT image beautifully demonstrates depression of the frontal sinus.

Facts: Frontal Sinus Fracture
  • Because of density, thickness and arched configuration of the anterior wall of frontal sinus, a fracture requires considerable force
  • Isolated frontal sinus fracture uncommon. Most fractures occur with other midface or intracranial injuries
  • Most common cause is blunt trauma
  • Late complications include aesthetic deformity, infection (sinus, intracranial), CSF leakage.
  • Anterior wall fracture
  • Posterior wall fracture
  • Combined anterior and posterior wall fracture
  • Decision for surgical exploration based on presence of displacement, depression, posterior wall involvement, CSF leakage, nasofrontal duct involvement
  • CT is the current gold standard for diagnosis
  • Look for fracture comminution, depression, involvement of posterior wall, degree of displacement and nasofrontal duct injury
  • Fracture extending to the base of frontal sinus and anterior ethmoid complex has a high likelihood of nasofrontal duct obstruction
  • Some surgeons advocate surgical management if a posterior wall fracture displaces more than one both width (higher likelihood of dural tear, CSF leak).
Thaller SR, McDonald WS. Facial trauma. Informa Health Care; 2004.
Joshi AS. Frontal sinus fracture. Emedicine, September 15, 2008.

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